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Casswell S, Huckle T, Parker K, Graydon‐Guy T, Leung J, Parry C, Torun P, Sengee G, Pham C, Gray‐Phillip G, Callinan S, Chaiyasong S, MacKintosh AM, Meier P, Randerson S. Effective alcohol policies are associated with reduced consumption among demographic groups who drink heavily. ALCOHOL, CLINICAL & EXPERIMENTAL RESEARCH 2023; 47:786-795. [PMID: 37087719 PMCID: PMC10947406 DOI: 10.1111/acer.15030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 01/24/2023] [Accepted: 01/30/2023] [Indexed: 04/24/2023]
Abstract
BACKGROUND Alcohol policies stand out among other noncommunicable disease-relevant policies for the lack of uptake. Composite indicators have been developed to measure the effects of alcohol control policy. We investigated whether drinking patterns among demographic groups from general population samples of drinkers from diverse countries are associated with alcohol control policy as measured by the International Alcohol Control (IAC) Policy Index. METHODS Representative samples of adult drinkers from 10 countries (five high-income and five middle-income) were surveyed about alcohol consumption, using beverage and location-specific questions. MEASUREMENTS The IAC Policy Index was analyzed with frequency, typical occasion quantity, and volume consumed. Analyses used mixed models that included interactions between country IAC Policy Index score and age group, gender, and education level. FINDINGS Each increase in IAC policy index score (reflecting more effective alcohol policy) was associated with a 13.9% decrease in drinking frequency (p = 0.006) and a 16.5% decrease in volume (p = 0.001). With each increase in IAC Policy Index score, both genders decreased for all three measures, but men less so than women. Women decreased their typical occasion quantity by 1.2% (p = 0.006), frequency by 3.1% (p < 0.001), and total volume by 4.2% (p < 0.001) compared to men. Low and mid-education groups decreased their typical occasion quantity by 2.6% (p < 0.001) and 1.6% (p = 0.001), respectively, compared to high education, while for drinking frequency the low education group increased by 7.0% (p < 0.001). There was an overall effect of age (F = 19.27, p < 0.0001), with 18-19 and 20-24-year-olds showing the largest decreases in typical occasion quantity with increasing IAC policy index score. CONCLUSIONS The IAC Policy Index, reflecting four effective policies, was associated with volume and frequency of drinking across 10 diverse countries. Each increase in the IAC Policy Index was associated with lower typical quantities consumed among groups reporting heavy drinking: young adults and less well-educated. There is value in implementing such alcohol policies and a need to accelerate their uptake globally.
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Affiliation(s)
- Sally Casswell
- SHORE & Whariki Research CentreCollege of Health, Massey UniversityAucklandNew Zealand
| | - Taisia Huckle
- SHORE & Whariki Research CentreCollege of Health, Massey UniversityAucklandNew Zealand
| | - Karl Parker
- SHORE & Whariki Research CentreCollege of Health, Massey UniversityAucklandNew Zealand
| | - Thomas Graydon‐Guy
- SHORE & Whariki Research CentreCollege of Health, Massey UniversityAucklandNew Zealand
| | - June Leung
- SHORE & Whariki Research CentreCollege of Health, Massey UniversityAucklandNew Zealand
| | - Charles Parry
- Alcohol, Tobacco and Other Drug Research Unit, South African Medical Research CouncilCape TownSouth Africa
| | - Perihan Torun
- Department of Public HealthHamidiye International Medical SchoolIstanbulTurkey
| | - Gantuya Sengee
- Public Health Policy and Coordination DepartmentNational Center for Public Health of MongoliaUlaanbaatarMongolia
| | - Cuong Pham
- Center for Injury Policy and Prevention Research (CIPPR)Hanoi University of Public HealthHanoiVietnam
| | | | - Sarah Callinan
- Centre for Alcohol Policy Research (CAPR), School of Psychology and Public HealthLa Trobe UniversityMelbourneVictoriaAustralia
| | - Surasak Chaiyasong
- International Health Policy Program (IHPP), Ministry of Public Health & Faculty of PharmacyMahasarakham UniversityMaha SarakhamThailand
| | - Anne Marie MacKintosh
- Institute for Social Marketing and Health, Faculty of Health Sciences and SportUniversity of StirlingStirlingUK
| | - Petra Meier
- School of Health and Related ResearchUniversity of SheffieldSheffieldUK
- Present address:
MRC/CSO Social and Public Health Sciences UnitUniversity of GlasgowGlasgowUK
| | - Steve Randerson
- SHORE & Whariki Research CentreCollege of Health, Massey UniversityAucklandNew Zealand
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Leung J, Casswell S, Parker K, Huckle T, Romeo J, Graydon‐Guy T, Byron K, Callinan S, Chaiyasong S, Gordon R, Harker N, MacKintosh AM, Meier P, Paraje G, Parry CD, Pham C, Williams PP, Randerson S, Schelleman‐Offermans K, Sengee G, Torun P, van Dalen W. Effective alcohol policies and lifetime abstinence: An analysis of the International Alcohol Control policy index. Drug Alcohol Rev 2023; 42:704-713. [PMID: 36423899 PMCID: PMC10947057 DOI: 10.1111/dar.13582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Revised: 09/29/2022] [Accepted: 11/03/2022] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Alcohol abstinence remains common among adults globally, although low and middle-income countries are experiencing declines in abstention. The effect of alcohol policies on lifetime abstinence is poorly understood. The International Alcohol Control (IAC) policy index was developed to benchmark and monitor the uptake of effective alcohol policies and has shown strong associations with alcohol per capita consumption and drinking patterns. Uniquely, the index incorporates both policy 'stringency' and 'impact', reflecting policy implementation and enforcement, across effective policies. Here we assessed the association of the IAC policy index with lifetime abstinence in a diverse sample of jurisdictions. METHODS We conducted a cross-sectional analysis of the relationship between the IAC policy index score, and its components, and lifetime abstinence among adults (15+ years) in 13 high and middle-income jurisdictions. We examined the correlations for each component of the index and stringency and impact separately. RESULTS Overall, the total IAC policy index scores were positively correlated with lifetime abstinence (r = 0.76), as were both the stringency (r = 0.62) and impact (r = 0.82) scores. Marketing restrictions showed higher correlations with lifetime abstinence than other policy domains (r = 0.80), including restrictions on physical availability, pricing policies and drink-driving prevention. DISCUSSION AND CONCLUSION Our findings suggest that restricting alcohol marketing could be an important policy for the protection of alcohol abstention. The IAC policy index may be a useful tool to benchmark the performance of alcohol policy in supporting alcohol abstention in high and middle-income countries.
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Affiliation(s)
- June Leung
- SHORE & Whariki Research Centre, College of HealthMassey UniversityAucklandNew Zealand
| | - Sally Casswell
- SHORE & Whariki Research Centre, College of HealthMassey UniversityAucklandNew Zealand
| | - Karl Parker
- SHORE & Whariki Research Centre, College of HealthMassey UniversityAucklandNew Zealand
| | - Taisia Huckle
- SHORE & Whariki Research Centre, College of HealthMassey UniversityAucklandNew Zealand
| | - Jose Romeo
- SHORE & Whariki Research Centre, College of HealthMassey UniversityAucklandNew Zealand
| | - Thomas Graydon‐Guy
- SHORE & Whariki Research Centre, College of HealthMassey UniversityAucklandNew Zealand
| | - Karimu Byron
- National Council on Drug Abuse PreventionBasseterreSt Kitts and Nevis
| | - Sarah Callinan
- Centre for Alcohol Policy Research, School of Psychology and Public HealthLa Trobe UniversityMelbourneAustralia
| | - Surasak Chaiyasong
- International Health Policy Program, Ministry of Public Health and Social Pharmacy Research Unit, Faculty of PharmacyMahasarakham UniversityMaha SarakhamThailand
| | - Ross Gordon
- Institute for Social Marketing and Health, Faculty of Health Sciences and SportUniversity of StirlingStirlingUK
- QUT Business SchoolQueensland University of TechnologyBrisbaneAustralia
| | - Nadine Harker
- Alcohol, Tobacco and Other Drug Research UnitSouth African Medical Research CouncilTygerbergSouth Africa
| | - Anne Marie MacKintosh
- Institute for Social Marketing and Health, Faculty of Health Sciences and SportUniversity of StirlingStirlingUK
| | - Petra Meier
- School of Health and Related ResearchUniversity of SheffieldSheffieldUK
- Social and Public Health Sciences UnitUniversity of GlasgowGlasgowUK
| | | | - Charles D. Parry
- Alcohol, Tobacco and Other Drug Research UnitSouth African Medical Research CouncilTygerbergSouth Africa
| | - Cuong Pham
- Center for Injury Policy and Prevention ResearchHanoiVietnam
| | - Petal Petersen Williams
- Alcohol, Tobacco and Other Drug Research UnitSouth African Medical Research CouncilTygerbergSouth Africa
- Department of Psychiatry and Mental HealthUniversity of Cape TownCape TownSouth Africa
| | - Stephen Randerson
- SHORE & Whariki Research Centre, College of HealthMassey UniversityAucklandNew Zealand
| | - Karen Schelleman‐Offermans
- Maastricht UniversityWork & Social Psychology, Faculty of Psychology & NeuroscienceMaastrichtThe Netherlands
| | - Gantuya Sengee
- Public Health Policy and Coordination DepartmentNational Center for Public Health of MongoliaUlaanbaatarMongolia
| | - Perihan Torun
- Department of Public HealthHamidiye International Medical SchoolIstanbulTurkey
| | - Wim van Dalen
- Dutch Institute for Alcohol Policy STAPUtrechtThe Netherlands
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Foster S, Estévez-Lamorte N, Walitza S, Mohler-Kuo M. The Impact of the COVID-19 Pandemic on Young Adults' Mental Health in Switzerland: A Longitudinal Cohort Study from 2018 to 2021. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:2598. [PMID: 36767967 PMCID: PMC9915161 DOI: 10.3390/ijerph20032598] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Revised: 01/23/2023] [Accepted: 01/28/2023] [Indexed: 06/18/2023]
Abstract
Most of the studies that examine the effect of the COVID-19 pandemic on mental health have been restricted to pandemic mental health data alone. The aim of the current study was to estimate the pandemic's effect on young Swiss adults' mental health by comparing pandemic to pre-pandemic mental health. Longitudinal data of 1175 young Swiss adults who participated in the S-YESMH study in 2018 and were followed-up in 2020 and 2021 were analyzed. The study outcomes were self-reported symptoms of depression, generalized anxiety disorder (GAD), attention-deficit/hyperactivity disorder (ADHD), thoughts about death or self-harm, and risky single-occasion drinking (RSOD). Generalized estimation equations, logistic regression and statistical mediation analysis were used to analyze the data. Evidence was found of increased depression, GAD, and ADHD among young women and increased depression among young men, resulting from the COVID-19 pandemic. Uncertainty about the future predicted young women's depression and anxiety in 2021. COVID-19 stress in 2021 fully mediated the effect of COVID-19 stress in 2020 on depression and GAD in 2021. Young Swiss women's and men's mental health appears to have been adversely affected by the COVID-19 pandemic, especially during the second pandemic year. Uncertainty about the future and stress becoming chronic in 2021 likely explain some of the adverse effects.
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Affiliation(s)
- Simon Foster
- Department of Child and Adolescent Psychiatry and Psychotherapy, Psychiatric University Hospital Zurich, University of Zurich, 8032 Zurich, Switzerland
| | - Natalia Estévez-Lamorte
- Department of Child and Adolescent Psychiatry and Psychotherapy, Psychiatric University Hospital Zurich, University of Zurich, 8032 Zurich, Switzerland
- La Source, School of Nursing Sciences, HES-SO University of Applied Sciences and Arts of Western Switzerland, 1004 Lausanne, Switzerland
| | - Susanne Walitza
- Department of Child and Adolescent Psychiatry and Psychotherapy, Psychiatric University Hospital Zurich, University of Zurich, 8032 Zurich, Switzerland
| | - Meichun Mohler-Kuo
- Department of Child and Adolescent Psychiatry and Psychotherapy, Psychiatric University Hospital Zurich, University of Zurich, 8032 Zurich, Switzerland
- La Source, School of Nursing Sciences, HES-SO University of Applied Sciences and Arts of Western Switzerland, 1004 Lausanne, Switzerland
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Foster S, Gmel G, Mohler-Kuo M. Young Swiss men's risky single-occasion drinking: Identifying those who do not respond to stricter alcohol policy environments. Drug Alcohol Depend 2022; 234:109410. [PMID: 35364420 DOI: 10.1016/j.drugalcdep.2022.109410] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Revised: 02/24/2022] [Accepted: 03/13/2022] [Indexed: 11/03/2022]
Abstract
BACKGROUND Previous research has demonstrated a preventive effect of the alcohol policy environment on alcohol consumption. However, little is known about the heterogeneity of this effect. Our aim was to examine the extent of heterogeneity in the relationship between the strictness of alcohol policy environments and heavy drinking and to identify potential moderators of the relationship. METHODS Cross-sectional data from 5986 young Swiss men participating in the cohort study on substance use risk factors (C-SURF) were analysed. The primary outcome was self-reported risky single-occasion drinking in the past 12 months (RSOD, defined as 6 standard drinks or more on a single occasion at least monthly). A previously-used index of alcohol policy environment strictness across Swiss cantons was analysed in conjunction with 21 potential moderator variables. Random forest machine learning captured high-dimensional interaction effects, while individual conditional expectations captured the heterogeneity induced by the interaction effects and identified moderators. RESULTS Predicted subject-specific absolute risk reductions in RSOD risk ranged from 16.8% to - 4.2%, indicating considerable heterogeneity. Sensation seeking and antisocial personality disorder (ASPD) were major moderators that reduced the preventive relationship between stricter alcohol policy environments and RSOD risk. They also were associated with the paradoxical observation that some individuals displayed increased RSOD risk in stricter alcohol policy environments. CONCLUSION Whereas stricter alcohol policy environments were associated with reduced average RSOD risk, additionally addressing the risk conveyed by sensation seeking and ASPD would deliver an interlocking prevention mix against young Swiss men's RSOD.
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Affiliation(s)
- Simon Foster
- Department of Child and Adolescent Psychiatry and Psychotherapy (KJPP), University Hospital of Psychiatry Zurich, University of Zurich, Zurich, Switzerland.
| | - Gerhard Gmel
- Addiction Medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland, Addiction Switzerland, Lausanne, Switzerland, Centre for Addiction and Mental Health, Toronto, Ontario, Canada, University of the West of England, Frenchay Campus, Bristol, UK
| | - Meichun Mohler-Kuo
- La Source, School of nursing sciences, HES-SO University of Applied Sciences and Arts of Western Switzerland, Lausanne, Switzerland, Department of Child and Adolescent Psychiatry and Psychotherapy (KJPP), University Hospital of Psychiatry Zurich, University of Zurich, Zurich, Switzerland
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Vallance K, Vincent A, Schoueri-Mychasiw N, Stockwell T, Hammond D, Greenfield TK, McGavock J, Hobin E. News Media and the Influence of the Alcohol Industry: An Analysis of Media Coverage of Alcohol Warning Labels With a Cancer Message in Canada and Ireland. J Stud Alcohol Drugs 2020. [PMID: 32359058 PMCID: PMC7201216 DOI: 10.15288/jsad.2020.81.273] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE Media coverage of alcohol-related policy measures can influence public debate and is often more aligned with interests of the alcohol industry than public health. The purpose of this study was to examine the framing of news coverage of alcohol warning label (AWL) initiatives that included a cancer message on alcohol containers in two different countries. Policy contexts and industry perspectives were also evaluated. METHOD We identified and systematically reviewed news articles published between 2017-2019 covering an AWL academic study in Yukon, Canada, and labeling provisions in a Public Health (Alcohol) Bill in Ireland. Both included a cancer message. News stories were coded for media type and topic slant; inclusion of alcohol industry perspectives was examined using content analysis. RESULTS Overall, 68.4% of media articles covering the Yukon Study (n = 38) and 18.9% covering the Ireland Bill (n = 37) were supportive of AWLs with a cancer message. The majority of articles in both sites presented alcohol industry perspectives (Yukon, 65.8%; Ireland, 86.5%), and industry arguments opposing AWLs were similar across both contexts. In articles with statements from industry representatives, the label message was frequently disputed by distorting or denying the evidence that alcohol causes cancer (n = 33/43). CONCLUSIONS News coverage of AWLs with a cancer message was more supportive in Canada than Ireland, where alcohol industry perspectives were consistently foregrounded. Industry arguments opposing the cancer label bore similarities across contexts, often distorting or denying the evidence. Increasing awareness of industry messaging strategies may generate more critical coverage of industry lobbying activities and increase public support for alcohol policies.
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Affiliation(s)
- Kate Vallance
- Canadian Institute for Substance Use Research, University of Victoria, Victoria, British Columbia, Canada
| | | | - Nour Schoueri-Mychasiw
- Health Promotion, Chronic Disease and Injury Prevention, Public Health Ontario, Toronto, Ontario, Canada
| | - Tim Stockwell
- Canadian Institute for Substance Use Research, University of Victoria, Victoria, British Columbia, Canada
| | - David Hammond
- School of Public Health & Health Systems, University of Waterloo, Waterloo, Ontario, Canada
| | - Thomas K Greenfield
- Alcohol Research Group, Public Health Institute, Emeryville, California, United States
| | - Jonathan McGavock
- Department of Pediatrics and Child Health, Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Erin Hobin
- Health Promotion, Chronic Disease and Injury Prevention, Public Health Ontario, Toronto, Ontario, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
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Lemoine M, Gmel G, Foster S, Marmet S, Studer J. Multiple trajectories of alcohol use and the development of alcohol use disorder: Do Swiss men mature-out of problematic alcohol use during emerging adulthood? PLoS One 2020; 15:e0220232. [PMID: 31986142 PMCID: PMC6984690 DOI: 10.1371/journal.pone.0220232] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2018] [Accepted: 07/11/2019] [Indexed: 12/31/2022] Open
Abstract
(A) OBJECTIVE This study aimed to identify trajectories of alcohol use (AU) and their associations with the development of alcohol use disorder (AUD) among young men with different weekly drinking patterns. (B) METHOD A longitudinal latent class analysis integrating several aspects of AU, such as drinking quantity and frequency on weekends vs workweek days, involving 4719 young Swiss men at ages 20, 21, and 25, and collected by the Cohort Study on Substance Use Risk Factors, was used to identify different AU trajectories over time. The development of AUD scores in these trajectories was investigated using generalized linear mixed models. (C) RESULTS Six AU trajectory classes, similar to those described in the literature, were identified: 'abstainers-light drinkers', 'light workweek increasers', 'light decreasers', 'moderate weekend decreasers', 'moderate workweek increasers', and 'heavy drinkers'. Only 12% of participants were assigned to a trajectory class with decreasing AU associated with a decline in their AUD score. AUD scores increased in trajectory classes exhibiting increasing AU on workweek days, despite low and moderate general AU. Finally, more than 59% of participants were on an AU trajectory presenting no change in their mean AUD score over time. (D) CONCLUSIONS Maturing out of problematic AU in emerging adulthood is not the norm in Switzerland, and the AUD score developed in late adolescence remains until at least emerging adulthood. AU on workweek days is a more practical marker of potentially problematic AU. This calls for timely interventions in adolescence and concerning regular drinking on workweek days in emerging adulthood.
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Affiliation(s)
- Mélissa Lemoine
- Addiction Medicine, Lausanne University Hospital CHUV, Rue du Bugnon, Lausanne, Switzerland
| | - Gerhard Gmel
- Addiction Medicine, Lausanne University Hospital CHUV, Rue du Bugnon, Lausanne, Switzerland
- Addiction Switzerland, Lausanne, Switzerland
- Centre for Addiction and Mental Health, Toronto, ON, Canada
- University of the West of England, Bristol, United Kingdom
| | - Simon Foster
- Swiss Research Institute for Public Health and Addiction at Zurich University, Konradstrasse, Zurich, Switzerland
| | - Simon Marmet
- Addiction Medicine, Lausanne University Hospital CHUV, Rue du Bugnon, Lausanne, Switzerland
| | - Joseph Studer
- Addiction Medicine, Lausanne University Hospital CHUV, Rue du Bugnon, Lausanne, Switzerland
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Weerasinghe A, Schoueri-Mychasiw N, Vallance K, Stockwell T, Hammond D, McGavock J, Greenfield TK, Paradis C, Hobin E. Improving Knowledge that Alcohol Can Cause Cancer is Associated with Consumer Support for Alcohol Policies: Findings from a Real-World Alcohol Labelling Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E398. [PMID: 31936173 PMCID: PMC7014334 DOI: 10.3390/ijerph17020398] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Revised: 11/20/2019] [Accepted: 11/21/2019] [Indexed: 12/25/2022]
Abstract
Knowledge that alcohol can cause cancer is low in Canada. Alcohol labels are one strategy for communicating alcohol-related harms, including cancer. Extending existing research observing an association between knowledge of the alcohol-cancer link and support for alcohol policies, this study examined whether increases in individual-level knowledge that alcohol is a carcinogen following an alcohol labelling intervention are associated with support for alcohol polices. Cancer warning labels were applied to alcohol containers at the intervention site, and the comparison site did not apply cancer labels. Pre-post surveys were conducted among liquor store patrons at both sites before and two-and six-months after the intervention was stopped due to alcohol industry interference. Limiting the data to participants that completed surveys both before and two-months after the cancer label stopped, logistic regression was used to examine the association between increases in knowledge and support for policies. Support for pricing and availability policies was low overall; however, increases in individual-level knowledge of the alcohol-cancer link was associated with higher levels of support for pricing policies, specifically, setting a minimum unit price per standard drink of alcohol (OR = 1.86, 95% CI: 1.11-3.12). Improving knowledge that alcohol can cause cancer using labels may increase support for alcohol policies. International Registered Report Identifier (IRRID): RR2-10.2196/16320.
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Affiliation(s)
| | | | - Kate Vallance
- Canadian Institute for Substance Use Research, University of Victoria, Victoria, BC V8P 2Y2, Canada; (K.V.); (T.S.)
| | - Tim Stockwell
- Canadian Institute for Substance Use Research, University of Victoria, Victoria, BC V8P 2Y2, Canada; (K.V.); (T.S.)
| | - David Hammond
- School of Public Health and Health Systems, University of Waterloo, Waterloo, ON N2L 3G1, Canada;
| | - Jonathan McGavock
- Children’s Hospital Research Institute of Manitoba, University of Manitoba, Winnipeg, MB R3E 3P4, Canada;
| | | | - Catherine Paradis
- Canadian Centre for Substance Use and Addiction, Ottawa, ON K1P 5E7, Canada;
| | - Erin Hobin
- Public Health Ontario, Toronto, ON M5G 1V2, Canada; (A.W.); (N.S.-M.)
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